PCS Lease Process Form

Please read our compliance statements

School or Facility

First Use Date

Date

Last Use Date

Date

Full Legal name of individual or group leasing the school

(Name of the “insured” as it appears on the certificate of Liability Insurance)

If this is an athletic team, is this an outside group or school based off-season team?

Full mailing address of leasing individual or group. - No P.O. Boxes

Contact Person for Lease

First NameLast Name

Daytime phone number of contact person

Please enter a valid phone number.Format: (000) 000-0000.

E-mail for contact person

example@example.com

Describe the nature of the use or activity

Is the individual or group 501(c)(3)non-profit? If yes a letter must be sent to leasing office prior to approval.

If booster fundraiser, will funds run through school acct. or booster acct.?

Rooms, fields, stadiums, ball-fields, pool, etc., to be used. Completely list the facilities, associated dates, and times of their use. Please be thorough to prevent additional follow-up which may lead to processing delays.

Rooms & Fields to be used

Enter any equipment that will be provided to lessee (i.e. stage lights/spotlights, audio/visual type, sporting equipment type; computers; musical instruments, etc.)

Dates of Use

Total Number of Days

How many people are expected to attend the event

Time you will arrive at facility

(This is not the time the event starts) Minutes Minutes

AM/PM Option

Time you will leave facility

(This is not the time the event will end) Minutes Minutes

AM/PM Option

Enter any outside lighting, lining of field, pool heater use required/needed

Will set-up and or clean-up be required for plant operator staff (i.e. setting up chairs, tables, etc.)?

Name of person/administrator at school who has approved your request for this lease.

First NameLast Name

Position of individual at school.

If you have not received approval from a school district employee do not submit this form. Submittal of lease information without school district approval may result in the cancellation of the facility use.